Managing Traumatic Hyphema: Medical Interventions Investigated

A total of 2643 patients from 20 randomized and 7 quasi-randomized trials were included in the review

According to the findings of a recently published study, visual acuity following traumatic hyphema, or blood entry into the anterior chamber of the eye, was not successfully managed by any medical interventions.

The study authors utilized a variety of search engines to obtain randomized and quasi-randomized trials assessing the efficacy of various medical interventions used in the treatment of traumatic hyphema following closed-globe trauma. Data was extracted for the primary outcomes of visual acuity and primary hemorrhage resolution time by 2 independent authors and were reported as risk ratios (RR) as well as mean differences (MD).

A total of 2643 patients from 20 randomized and 7 quasi-randomized trials were included in the review. Interventions included in the studies were: antifibrinolytic agents (systemic and topical aminocaproic acid, tranexamic acid, aminomethylbenzoic acid), systemic and topical corticosteroids, cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular vs bilateral patching, elevating the head, as well as bed rest.

“We found no evidence of an effect on visual acuity for any intervention, whether measured within 2 weeks (short term) or for longer periods,” the study authors reported. In 2 trials evaluating aminocaproic acid, no evidence was found on its effect on long-term visual acuity (RR: 1.03; 95% CI: 0.82, 1.29) or final visual acuity up to 3 years following the hyphema (RR: 1.05; 95% CI: 0.93, 1.18). Data analysis also found that no intervention resulted in a statistically significant effect on short-term visual acuity (8 trials; RR: 0.75-1.10).

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“Similarly, visual acuity measured for longer periods in 4 trials evaluating different interventions was also not statistically significant (RRs ranged from 0.82 to 1.02),” the study authors added. It was noted that the data supporting these results was considered to be of low or very low certainty.

Limited data also showed that patients treated with antifibrinolytic agents were less likely to experience recurrent hemorrhage, but the hyphema took longer to resolve in those treated with systemic aminocaproic acid compared with no use.

“As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value,” the authors concluded.